As a person continues to age, tooth loss inevitably occurs, and tooth replacement, as provided by the dental profession, is often employed to make up for the tooth loss. One of the more important aspects of this replacement procedure is that the sulcus (e.g., soft tissue complex as impacted by hard tissue/bone structure of the mouth) as attached to the cortical occlusal bone and provides the free gingival margin (e.g. the gum line surrounding the [now lost] tooth or the replacement crown) changes once the natural tooth is removed. In some cases, the bone portion (or hard tissue) of the mouth where the tooth was formerly anchored, can, through the normal healing process, compact upon itself and as result change the bone line while gum tissue from that portion of mouth can also recede or become thinner thus changing the overall profile of cortical plate or jaw shape at that point. These changes may make the establishment of an implant surgical site (with corresponding, eventual placement of a dental crown upon a dental implant at the implant surgical site) more difficult, especially in those areas such as the front of the mouth where the bone and tissue are much thinner structures with corresponding less material to anchor the dental implant. This change in profile may result in a limitation of the needed telemetry and other implant orientations for proper implant placement and anchorage, and well as, unless otherwise corrected, ultimately place the dental crown in a position within the mouth that would appear to be out of alignment or otherwise appear to be in an unnatural placement in relation to the surrounding teeth. The new crown may properly support the bite of the patient but appear to have an unnatural orientation, calling attention to the crown, thus defeating one of the cosmetic purposes of tooth replacement: that persons observing the patient's smile should not notice the occurrence of dental implant/tooth replacement.
What dentistry has attempted in the past is use a healing abutment to manually rectify these changes in bone and sulcus and improve the operation site for the placement of the implant. Such healing abutments in manufacture generally have a circular lateral cross section, substantially generic in construction; and generally do not provide a profile that is patient-specific, or much less tooth-specific, for proper growth of a desired sulcus profile that could match the base of the dental crown, match the overall presentation of the remaining teeth, in a manner that is both healthy and elastically pleasing.
In operation, after the soft tissue is cut and removed to designate implant surgical site, the dental implant is secured to the implant surgical site, the bottom of the implant being embedded into the bone. A healing abutment is then attached to the exposed top portion of the dental implant. Once the tissue healing (and bone solidification/osseointegration around the buried/artificial root portion of the implant) has finalized, the healing abutment is replaced with a final abutment, with the healing abutment being discarded. Procedures are then utilized as needed to place and permanently secure the dental crown to the healing abutment/dental implant combination.
However, if the sulcus did not heal properly or grew away from the dental implant and does not provide an appropriate free gingival margin (e.g., gum line) and the like, further surgical procedures may be implemented to manually sculpt the soft tissue (and possibly bone) as required to generally bring the sulcus into a proper orientation and required contact with the placed dental crown. These post operative procedures are costly, painful, as well as time-consuming.
What is needed therefore is a pre-surgical digital method or process and associated apparatus wherein computer virtual modeling utilizes and merges DICOM data sets taken from the patient's mouth such as a CBCT scan (for the bone structure, root trajectory, and alike); optical scan data; scanned physical impressions/castings (for tissue structure); digital impression, and the like to create pre-dental implant surgery, a virtual model of what the desired emergent sulcus for the proposed implant site should be. Utilizing this digital data prior to implant surgery, a temporary (e.g., disposable) healing abutment can be virtually designed to meet a desired emergent sulcus profile. By virtually placing such a healing abutment upon a virtual implant body at a virtual implant operation site, the dimensions of the healing abutment can be checked to see that when the healing abutment is actually placed at the surgical implant site that it could properly support the development of the projected desired emergent sulcus profile; when the final abutment is actually placed at the surgical implant site that it could properly support emergent sulcus profile as predicted; when emergent sulcus profile is obtained that could not only properly accommodate the placed crown. In this manner, the overall combination of the developed emergent sulcus, implant, healing abutment, and crown could also substantially match the patient's natural overall sulcus profile and gingival harmony.